Perez Ferrer Carolina, McMunn Anne, Rivera Dommarco Juan A, Brunner Eric J
Research Department of Epidemiology and Public Health, University College London, London, United Kingdom.
Centro de investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, México.
PLoS One. 2014 Mar 5;9(3):e90195. doi: 10.1371/journal.pone.0090195. eCollection 2014.
Obesity is one of the leading causes of global morbidity and mortality. Trends in educational inequalities in obesity prevalence among Mexican women have not been analysed systematically to date.
Data came from four nationally representative surveys (1988, 1999, 2006, and 2012) of a total of 51 220 non-pregnant women aged 20 to 49. Weight and height were measured during home visits. Education level (higher education, high school, secondary, primary or less) was self-reported. We analysed trends in relative and absolute educational inequalities in obesity prevalence separately for urban and rural areas.
Nationally, age-standardised obesity prevalence increased from 9.3% to 33.7% over 25 years to 2012. Obesity prevalence was inversely associated with education level in urban areas at all survey waves. In rural areas, obesity prevalence increased markedly but there was no gradient with education level at any survey. The relative index of inequality in urban areas declined over the period (2.87 (95%CI: 1.94, 4.25) in 1988, 1.55 (95%CI: 1.33, 1.80) in 2012, trend p<0.001). Obesity increased 5.92 fold (95%CI: 4.03, 8.70) among urban women with higher education in the period 1988-2012 compared to 3.23 fold (95%CI: 2.88, 3.63) for urban women with primary or no education. The slope index of inequality increased in urban areas from 1988 to 2012. Over 0.5 M cases would be avoided if the obesity prevalence of women with primary or less education was the same as for women with higher education.
The expected inverse association between education and obesity was observed in urban areas of Mexico. The declining trend in relative educational inequalities in obesity was due to a greater increase in obesity prevalence among higher educated women. In rural areas there was no social gradient in the association between education level and obesity across the four surveys.
肥胖是全球发病和死亡的主要原因之一。迄今为止，墨西哥女性肥胖患病率的教育不平等趋势尚未得到系统分析。
数据来自四项具有全国代表性的调查（1988年、1999年、2006年和2012年），共纳入51220名年龄在20至49岁的非孕妇女性。在家访期间测量体重和身高。教育水平（高等教育、高中、初中、小学及以下）由受访者自报。我们分别分析了城乡地区肥胖患病率相对和绝对教育不平等的趋势。
在全国范围内，到2012年的25年间，年龄标准化肥胖患病率从9.3%上升至33.7%。在所有调查阶段，城市地区肥胖患病率与教育水平呈负相关。在农村地区，肥胖患病率显著上升，但在任何调查中与教育水平均无梯度关系。在此期间，城市地区不平等相对指数下降（1988年为2.87（95%CI：1.94，4.25），2012年为1.55（95%CI：1.33，1.80），趋势p<0.001）。1988 - 2012年期间，城市高等教育女性肥胖增加了5.92倍（95%CI：4.03，8.70），而小学及以下教育水平的城市女性肥胖增加了3.23倍（95%CI：2.88，3.63）。城市地区不平等斜率指数从1988年到2012年有所增加。如果小学及以下教育水平女性的肥胖患病率与高等教育女性相同，将避免超过50万例肥胖病例。
在墨西哥城市地区观察到教育与肥胖之间预期的负相关关系。肥胖相对教育不平等的下降趋势是由于高学历女性肥胖患病率上升幅度更大。在农村地区，四项调查中教育水平与肥胖之间均无社会梯度关系。
